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Unraveling the mystery of what causes rosacea has led medical researchers to look in many different directions. One interesting but controversial question revolves around the role a common stomach bacterium called Helicobacter pylori, or H. pylori, may play in the skin disease.

H. pylori infection is a leading cause of ulcers. As much as half the world's population is infected with the bacterium. People living in unsanitary conditions are most likely to catch it. H. pylori can weaken the mucus coating of the stomach that protects the lining from being irritated by digestive juices. In addition to ulcers, H.pylori can cause chronic gastritis, which is stomach inflammation. It's also linked to some cases of stomach cancer. H. pylori symptoms include abdominal pain and bloating. However, in many infected people, there are no H. pylori symptoms at all.

According to the National Rosacea Society (NRS), H. pylori may raise levels of the hormone gastrin, which regulates acid production in the stomach and could contribute to the flushing seen in rosacea. However, recent studies have shown that H. pylori infection is no more common in people with rosacea than in those who don't have it, according to the NRS.

Larry Millikan MD, FAAD, professor and chair emeritus of the department of dermatology at the Tulane University School of Medicine in New Orleans, says doctors first noticed a possible connection between rosacea and H. pylori almost by accident. "We had patients who had a remission in their rosacea when treated for H. pylori," Dr. Millikan says. In the years since, researchers have been investigating the link more closely. "Different studies have given varying results so there is continuing controversy," he adds.

Rosacea and H. Pylori: What Some Research Shows

A Turkish study investigated whether killing H. pylori infection in people with rosacea would help clear the skin. The researchers found that rosacea significantly improved at the end of standard treatment with antibiotics and other drugs. They concluded that H.pylori plays some role in rosacea and medication that kills the bacteria might be an effective treatment for rosacea.

However, a placebo-controlled study of 44 people with rosacea and H. pylori in the United States done at the same time didn't come up with the same results. Half were treated with medications for two weeks to kill the infection and half were given a placebo. Two months after treatment, researchers found that rosacea in both groups improved, so H. pylori treatment worked no better than the placebo. The researchers concluded their study could not support the idea that H. pylori infection is a cause for rosacea.

A more recent Spanish study did find that treatment for H. pylori was beneficial, especially for people with more advanced papulopustular rosacea, the kind that causes red bumps and pimples.

H. Pylori Medication as Treatment for Rosacea

Millikan says despite the contradictory studies, he believes that for some people rosacea may be improved by treating the infection. He says people whose skin hasn't responded to standard rosacea treatments and have tested positive for H. pylori, deserve a trial of triple therapy, which includes two antibiotics and milk of magnesia. But, he adds, "You don't use triple therapy just on a hunch." Treatment is complicated and might not be covered by insurance in all cases, he points out.

Doctors have seen many connections between bowel disease and skin problems. Says Millikan, "Simplistically, I look on the situation as the skin reacting to antigens, bacteria, proteins, etc. that are not absorbed by the normal gut and get into circulation when inflammatory conditions are in the bowel." Anecdotally, he recalls one patient who developed a skin rash every time his colitis flared up.

The Search for Rosacea Causes

Discovering a cause for rosacea could lead to better rosacea treatments and possibly a cure. It's believed many factors may play a role in rosacea, especially genetics. Other possible causes include vascular or immune system problems, an overabundance of a skin protein that may trigger inflammation, and nervous system problems. Another interesting theory is that a common skin mite called Demodex may play some sort of role.

Millikan says there's lots of promising research going on, but research dollars are scarce. He adds that much about the skin disease remains a mystery to doctors: "Rosacea is like a 5,000-piece jigsaw puzzle, and we only have 200 pieces in place."

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